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tolmetin (Tolectin)
Tradename: Tolectin.
Indications:
- temporary relief of minor aches, pains, fever & inflammation
Dosage:
1) 200-600 mg PO TID; maximum 1800 mg/day
2) expect a therapeutic response in a few days to a week
3) if GI irritation occurs, give with an antacid
4) bioavailability is affected by food & milk
Pharmacokinetics:
1) primarily metabolized by oxidation
2) elimination 1/2 life is 5 hours [3]
Adverse effects:
1) GI distress
2) GI bleeding
3) nausea
4) headache
5) higher frequency of anaphylactoid reactions than other NSAIDs
6) aseptic meningitis
7) rarely leukopenia, thrombocytopenia, hemolytic anemia
Drug interactions:
1) corticosteroids
a) increase the clearance of salicylates
b) increase the nephrotoxicity & GI toxicity of NSAIDs
2) decreased antihypertensive effects of ACE inhibitors
3) warfarin: prolonged bleeding time
4) tolmetin decreases clearance & increases toxicity of:
a) methotrexate
b) Li+
c) digoxin
Laboratory:
1) specimen: serum, plasma, urine
2) methods:
a) serum/plasma: HPLC, GC
b) urine: TLC
Mechanism of action:
1) acetic acid class NSAID
2) analgesic, antipyretic, anti-inflammatory
3) non-selective cyclooxygenase inhibitor
Interactions
drug interactions
drug adverse effects of NSAIDs
monitor with non steroidal anti-inflammatory agents (NSIADs)
General
non-steroidal anti-inflammatory agent (NSAID)
Properties
INHIBITS: cyclooxygenase
MISC-INFO: elimination route LIVER
1/2life 1.0-1.5 HOURS
5 HOURS
protein-binding >99%
elimination by hemodialysis -
peritoneal dialysis -
pregnancy-category C
safety in lactation -
Database Correlations
PUBCHEM correlations
References
- The Pharmacological Basis of Therapeutics, 9th ed.
Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- Saunders Manual of Medical Practice, Rakel (ed),
WB Saunders, Philadelphia, 1996, pg 792
- Drug Information & Medication Formulary, Veterans Affairs,
Central California Health Care System, 1st ed., Ravnan et al
eds, 1998 - not on National VA formulary
- Clinical Guide to Laboratory Tests, 3rd ed. Teitz ed.,
W.B. Saunders, 1995